Subrogation and Reimbursement

A health plan can generally recover medical expenses it has paid on behalf of a plan beneficiary who is injured in an accident and subsequently receives monetary damages from third parties.

A subrogation and/or reimbursement provision (also known as an “Acts of Third Parties” provision) generally provides that when a plan beneficiary is injured as a result of a third party’s acts or omissions, the plan will provide coverage in connection with the injury, but requires the beneficiary to reimburse the plan from any recovery he or she receives from the third party.